Related Experiment Video
Updated: Jun 16, 2025
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary
Christian Sellin1, Ahmed Belmenai1, Margit Niethammer2
1Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, Germany.
Insights
Minimally invasive coronary artery bypass grafting via left anterior thoracotomy shows favorable midterm outcomes for multivessel disease. This sternum-sparing approach achieved high rates of arterial grafting and complete revascularization.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Coronary Artery Disease Treatment
Background:
- Minimally invasive cardiac surgery offers potential benefits over traditional sternotomy.
- The efficacy of sternum-sparing coronary revascularization for multivessel disease requires further investigation.
Purpose of the Study:
- To evaluate the midterm outcomes of minimally invasive total coronary revascularization using a left anterior thoracotomy approach.
- To assess the feasibility and safety of this technique in a broad patient population.
Main Methods:
- A consecutive series of 392 patients with multivessel coronary artery disease underwent coronary artery bypass grafting via left anterior minithoracotomy.
- The study included patients with complex comorbidities, such as advanced age, reduced ejection fraction, diabetes, obesity, and chronic lung disease.
- Midterm follow-up data were collected for all patients, with a mean follow-up of 15.2 months.
Main Results:
- Complete anatomical revascularization was achieved in 95.1% of patients.
- The use of arterial grafts, including left internal thoracic artery and radial artery, was high (70.4% received at least 2 arterial grafts).
- Midterm outcomes showed an 8.7% rate of major adverse cardiac and cerebrovascular events, including 3.1% all-cause mortality and 5.4% repeat revascularization.
Conclusions:
- Minimally invasive total coronary revascularization via left anterior thoracotomy is a feasible and effective sternum-sparing approach for multivessel coronary artery disease.
- The technique demonstrates favorable midterm outcomes comparable to conventional coronary artery bypass grafting, with high rates of arterial grafting and complete revascularization.
Objective:
A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy demonstrated promising early outcomes in unselected patients with coronary artery multivessel disease. Follow-up data are still missing.
Methods:
From November 2019 to September 2023, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed as a routine procedure in 392 consecutive, nonemergency patients (345 men; 67.0 ± 9.9 years; range, 32-88 years). All patients had multivessel coronary artery disease (77.6% 3-vessel-disease, 22.4% 2-vessel-disease, and 32.9% left main stenosis). Patients at old age (older than a 80 years, 12.5%), with severe left ventricular dysfunction (ejection fraction <30%, 7.9%), diabetes mellitus (34.9%), massive obesity (body mass index > 35, 8.9%), and chronic lung disease (17.1%) were included. Mean European System for Cardiac Operative Risk Evaluation II score was 2.9 ± 2.8. Mean midterm follow-up (100%) was 15.2 ± 10.7 months (range, 0.1-39.5 months).
Results:
Left internal thoracic artery (99.0%), radial artery (70.4%), and saphenous vein grafts (57.4%) were used, and 70.4% of patients received at least 2 arterial grafts. A total of 3.0 ± 0.8 anastomoses (range, 2-5 anastomoses) per patient were performed to revascularize the territories of left anterior descending (98.7%), circumflex (91.6%), and right coronary (70.9%) artery. Complete anatomical revascularization was achieved in 95.1%. At follow-up, all-cause-mortality, myocardial infarction, repeat revascularization, and stroke was 3.1%, 1.5%, 5.4%, and 0.7%, respectively. Overall major adverse cardiac and cerebrovascular events rate was 8.7%.
Conclusions:
This is the first report of midterm follow-up after routine sternum-sparing total coronary revascularization via left anterior thoracotomy for multivessel coronary artery disease with a high rate of multiple arterial grafting and complete anatomical revascularization. Outcome was favorable and similar to that of contemporary conventional coronary artery bypass grafting.
